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The game is viewed from a semi-top down perspective, and follows the movie's story. The player, controlling Rambo, has to find his lost equipment, locate the POW camp, rescue the hostages and make it back to the extraction point, while being pursued by constantly respawning enemies. Rambo starts off with just a Bowie knife and grenades (both of which have an unlimited supply, as with all the weapons), and gains points for killing the enemy, and for collecting the following equipment: Rocket Launcher, M16 Rifle, and Bow & Arrows (Explosive & Non Explosive).

The game was one of the first to feature controllable vehicles (a helicopter), and also one of the first to feature stealth elements.[2]

Most of its gameplay style is strikingly similar to that of Ikari Warriors (although the Sega Master System version is well known for its same concept), but the levels are not as repetitive.

The game was well received. Your Sinclair described it as "a thinking man's Commando. That game starts fast and gets faster until you end up like a one-man whirlwind. Rambo develops into a solid shoot'em up".

As of 2008, there is a remake available for the PC, with enhanced graphics, sound and music taken from the film's theatrical score. Gameplay remains unchanged. Another difference is that the enemies are more plentiful than the original.